go back

Michigan rates for HCPCS L5658

Addition to lower extremity, socket insert, above knee (AK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $263.03 / $380.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,659.59 / $3,162.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $549.54 / $575.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $363.08 / $645.65
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $1,047.13 / $1,174.90
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $436.52 / $676.08
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $363.08 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $436.52 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $257.04 / $363.08